Measuring the impact of community-based interventions on type 2 diabetes control during the COVID-19 pandemic in Cape Town – A mixed methods study

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic exposed the risks of poorly controlled noncommunicable diseases, especially in persons with diabetes. The pandemic outbreak in Cape Town, South Africa, required a rapid reorganisation of primary care services. Community-based measures were activated to ensure continuity of care by implementing home delivery of medication by community health workers. After five months of de-escalated chronic care, observations at an urban primary care facility suggested that noncommunicable disease patients had not overtly decompensated despite suspending regular in-facility services. This study attempted to understand what impact de-escalation of regular care and escalation of community-based interventions had on type 2 diabetes patients at this primary care facility.Methods: A mixed methods study design was used, consisting of data captured prospectively from diabetic patients who returned to the facility for routine care post-lockdown, as well as qualitative interviews to ascertain patients’ experiences of the home delivery service.Results: The data set included 331 (72%) patients in the home delivery group and 130 (28%) in the non-home delivery group. Regression analysis demonstrated a statistically significant relationship between home delivery and improved diabetic control (p 0.01), although this may be because of confounding factors. The mean glycaemic control was suboptimal both at baseline and post-lockdown in both groups. Interviews with 83 study patients confirmed the acceptability of the home delivery intervention.Conclusion: The rapid reorganisation of primary care services illustrates the versatility of a functional community-oriented primary care service, although not fully developed yet, to adapt to emerging community healthcare needs in the pandemic era.

Impact of COVID-19 on diabetes mellitus outcomes and care in sub-Saharan Africa: A scoping review

“…Affordability challenges were related to increased costs of medicines [13] and reduced individual or household income [37]. PLWD also experienced health service accessibility challenges reported as increased clinic waiting time [13] and limited transport means to healthcare facilities [16,51]. Type 1 DM-specific challenges were limited food access, reduced affordability of living costs and accessibility of DM care services [37].…”

“…The reorganisation of DM care delivery was in response to the challenges patients and healthcare facilities faced in accessing and delivering DM care services. The interventions included delivery of patient medicines to their homes through their community health workers [25,34,51], which addressed the risk of infection and mitigated the health facility accessibility challenges faced by patients during lockdowns [34]. At clinic level, routine non-communicable disease ‘walk-in’ clinics were replaced with a clinic booking system to manage patient appointments and control clinic patient numbers [34].…”

“…Patient-related health management challenges Self-management challenges [15,33,36,37] Affordability challenges [13,37] Health service accessibility challenges [13,37,51] DM care service delivery Health workforce challenges [13,34] challenges Healthcare infrastructure challenges [13] Health information challenges [25] Medicines and medical supplies [13] Re-organisation of DM care delivery Patient-level reorganisation of care access [25,34,51] Clinic-level reorganisation of management [34] Community-level re-organisation of community health worker services [25,34,51] Patient-related health management challenges…”

Community-based models of care for management of type 2 diabetes mellitus among non-pregnant adults in sub-Saharan Africa: a scoping review

“…Home Delivery of Medication(HDM) 36 intervention was developed due to difficulties faced in health facilities during the Coronavirus disease (COVID-19) pandemic. The aim of the intervention was to determine if patient follow-up in the community with HDM improved blood glucose control as shown in HbA1c levels, and acceptability by patients.…”

“…Characteristics of the four studies including design and intervention are summarized on table 2. The first study was a mixed-method study conducted in an urban setting in South Africa 36 . The quantitative aspect of this study was a prospective cohort with a non-randomly selected control group.…”